345 2nd St PPI23-0001 1 of 6 Building Alter permit applications, PAIS,Private provider statement, fence addendBuilding Permit Application
City of Atlantic Beach Building Department
800 Seminole Road; Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Buildinfi-Deptfa)coab.U5
updated 10/9/18
••ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Job Address: 545 2nd Street, Atlantic Beacli. FL 32233 Permit Number:
Legal Description 14.AU0FL0T16. E 1/2 lot la. BtocXA. Plail Subdivision Atlantic Bsscn
Valuation of Work (Replacement Cost) $ 12.800.00 Heated/Cooled SF 247
REH 169785-0000
Non- Heated/Cooled
Class of Work: DNew DAddition ClAlteration DRepair DMove DDemo □Pool 0Window/Door
Use of existing/proposed structure(s): DCommercial ^Residential
If an existing structure, is a fire sprinkler system installed?: DYes 0No
Will tree(s) be removed in association with orooosed oroiect? GYes (must submit senarate Tree Removal Permitl tTiNo
Enclose exisitng back patio. Replace all windows with hurricane Impact windows.
Florida Product Approval for multiple products use product approval form
Propeitv Owner Information
Name Mitra-Partow Soroushi
City Atlantic Beach State Pi-
Address 545 2nd Street
Zip 52233 Phone 214-770-1021
E-Mail mitrapartow@yahoo.com
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Dimension Construction
Address 1545 N. Liberty Street
Qualifying Agent Ramin Partow
City Jacksonville State Z'P 32233
Office Phone 904-249-6094 Job Site Contact Number 904-294-6094
State Certification/Registration W CGC1508799
Architect Name & Phone « Unroe Engineering. Jay Zarazei (407) 970-1046
Engineer's Name & Phone U
E-Mail Ramin@dimensionconstruction.bi2
OR Exempt □ Expiration Date 12/31/2023Workers Compensation Insurer American Builders Insurance Comparry
Application Is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the Issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and
there may be additional permits required from other governmental entities such as water management districts, state agencies, or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDEI^OR AN ATTORNEY BEFORERECORl||^^OURjNOTI(
M
OF COMMENCEMENT.
(Signature of Owner or Agent)
Sign^ and sworn to (or affirmedj before methis^^'^^v of
. . effZ5. by "
fature,
'ersonally Known OF
[ ] Produced Identificatii
Type of Identification:
^ BRITTANY FA YE DRIVERMY CO^fMISSION GG975700
EXPIRES: April 28,2024
(Signatbre of Contractor)
sworn to (or affirmed) before
, by
BRITTANY FAYE DRIVER
MY COMMISSION #GG975700EXPIRES: April 28, 2024(IK'^onaily Known OR
[ ] Produced Identification
Type of Identification:
PPI23-0001
By Mike Jones at 11:01 am, Feb 02, 2023
REVIEWED FOR CODE COMPLIANCE
Notice to Building Offlciai
of
Use of Private Provider
Project Name: 345 2nd Street windows and porch
Parcel Tax ID: 1 SQTSS-^OOO
Services to be provided: Plans Review Inspections 21
Note: If the notice applies to either private plan review or private inspection services the
Building Official may require, at his or her discretion, the private provider be used for
both services pursuant to Section 553.791(2) Flonda ^atute.
Private Provider Firm: The Barlev Consulting Group. LLP
Private Provider: John M. Barlev. II FAIA. Philip R. Robbins. PE
Address: 4168 Oxford Avenue: Jacksonville. FL 32210 .
Telephone: 904.387.5855 Fax: 904.387.5330
Email Address (Optional): iohn@barlevaroup.ora
Florida License. Registration or Certificate#: AA26001193. AR0005067 & PE24050
I have elected to use one or more private providers to provide building code plans review and/or
inspection services on the building that is the subject of the enclosed permit application, as
authorized by s. 553.791. Florida Statutes, i understand that the local building official may not
review the plans submitted or perform the required building inspections to detemnine compliance
with the applicable codes, except to the extent specified in said law. Instead, plans review and/or
required building inspections will be performed by licensed or certified personnel identified in the
application. The law requires minimum insurance requirements for such personnel, but I
understand that I may require more insurance to protect my interests. By executing this form. I
acknowledge that I have made inquiry regarding the competence of the licensed or certified
personnel and the level of their insurance and am satisfied that my interests are adequately
protected. I agree to indemnify, defend, and hold harmless the local govemment, the local building
official, and their building code enforcement personnel from any and all claims arising from my use
of these licensed or certified personnel to perform building code inspection services with respect to
the building that is the subject of the enclosed permit application.
I understand that the use of a private provider does not limit the authority of the Building Official to
review plans, make required inspections, or enforce the applicable codes within his or her charge.
If I make any changes to the listed private providers or the services to be provided by those private
providers. I shall, within 1 business day after any change, update this notice to reflect such
changes. The building plans review and/or inspection services provided by the private provider is
limited to building code compliance and does not include review for fire code, land use.
environmental or other codes.
1 of2
PPI23-0001
The following attachments are provided as required:
1. Qualification statements and/or resumes of the private provider and all duly
authorized representatives.
2. Proof of Insurance for professional and comprehensive liability in the amount of $1
million per occurrence relating to all services performed as a private provider,
including tail coverage for a minimum of 5 years subsequent to the performance of
building code inspection services.
Individual Corporation Partnership
(signature)
Print
Namei '■''"3 Panow-Sorousni
Address:
Atlantic Beacn FL 32233
Telephone
No,; 214.770-1021
Please use appropriate notary block.
STATE OF fiends.
COUNTY OF t>\DJ/U
Print Corporalion Name
By:
Print
Name:
Its;
Address;
Telephone
No.:
(signature)
Print Partnership Name
By:
(signature)
Print
Name;
Its;
Address:
Telephone
No.:
Individual
Before me, this
• 2Q23. personflll^appearedwho executed the foregoing instrument,
and acknowledged before me lhat same
Nvas executed for the purposes therein
expressed.
Corporation
Before me, this
appeared
of
day of.. 20 , personally
a corporation, on
behalf of the state corporation, who
executed the foregoing instrument and
acknowledged before me that same was
executed for the purposes therein
expressed.
Pereonall identification Type of identification produced
Signature
Notary Public: NOTARY STAMP BELOW
Print Name
Partnership
Before me, this day of
20 . personally
appeareda partner/agent on behalf of
a partnership, who executed the fore
going instrument and acknowledged
before me that same was executed
for the purposes therein expressed.
BRITTANY FAYE DRIVER
I my commission # GG975700EXPIRES; April 28,2024
2 Of 2
Fence Addendum
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Bullding-Dept(5)coab.us
updated 1/14/2021
PERMIT#
Job Address:Date:
345 2nd Street, Atlantic Beach, FL 32233 01/16/2023
Property Type:
iZl Residential
□ Commercial
Lot Type/ Features:
0 One Street frontage (interior lot)
□ More than one street frontage (corner lot, through lot,
etc.)
□ Swimming Pool
Fence Material:
tZi Wood
□ Chain Link
□ Vinyl
□ Block/ Stone (Plan details required for footings and/or
retaining walls)
□ Other
Fence Height (select all that apply):
□ Four Foot (4ft)
Gl Six Foot (6ft)
□ Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location offence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
□ Yes (must submit separate Revocable Encroachment Agreement)
^ No
Will tree(s) be removed in association with proposed project?
□ Yes (must submit separate Tree Removal Permit)
Ef No
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
PPI23-0001
PRODUa APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH. FLORIDA (*required)•ProjectAddress: 345 2nd Street, Atlantic Beach, FL 32233•Owner/Project Name: 345 2nd Street patlo enclosIng & window replacementAs required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, please provide the information and product approval number{s)for the building components listed below as applicable to the building construction project for the permit number listed above. You should contactyour product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewideproduct approval may be obtained at: www.floridabuilding.org.Category/SubcategoryManufacturerProduct DescriptionLimitation of UseState #Local#A. EXTERIOR DOORS1. SwingingJELD-WENNExterior Door16708.12. SlidingJELD-WENNImpact Sliding door21705.33. Sectional4. Garage Roll-Up5. Automatic6. OtherB. WINDOWS1. Single hungJELD-WENNImpact Window14095.42. Horizontal slider3. Casement4. Double hung5. Fixed6. Awning7. Pass-through8. Projected9. Mullion10. Wind breaker11. Dual action12. OtherPage 1 of 4 Updated 06/21/21PPI23-0001By Mike Jones at 11:04 am, Feb 02, 2023
Category/SubcategoryManufacturerProduct DescriptionUmitation of UseState#Local#C. PANEL WALL1. SidingJames HardieFiber Cement Board & Trim13223.42. Soffits3. EIFS4. Storefronts5. Curtain walls6. Wall louvers7. Glass block8. Membrane9. Greenhouse10. Synthetic stucco11. OtherD. ROOFING PRODUCTS1. Asphalt shingles2. Underlayments3. Roofing fasteners4. Nonstructural metalroof5. Built-up roofing6. Modified bitumen7. Single ply roofing8. Roofing tiles9. Roofing insulation10. Waterproofing11. Wood shingles/shakes12. Roofing slate13. Liquid applied roofing14. Cement-adhesivecoats15. Roof tile adhesive16. Spray appliedpolyurethane roof17. OtherPage 2 of 4 Updated 06/21/21
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, theContractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installationinstructions along with this Product Approval Sheet.I certify that this product approval list is true and correct to the best of my knowledge. 1 further certify that use of different components other than theones listed in this document must be approved by the Building Official.*Contractor Name (Print Name): PSftOW *Contractor Signature:♦company Name: Dimension Construction. 1045 N. Liberty Street*Mailing Address:♦City: Jacksonville FL ^ode: 32206. 904-249-6094 raniin@dirnensionconstruction.biz*Telephone Number: *E-mail Address:904-294-6094Cell Phone Number: Fax Number:Page 4 of 4 Updated 06/21/21